COMPLIANCE INFO_1985-2003 - Laserfiche WebLink

Home Browse Search

'.meg u 3 C l , . STATE OF CALIFORNIA • a ' o STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMP E A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT 3 RENEWAL PERMIT 17q�5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ONSITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ d AMENDED PERMIT j❑—� �g TEMPORARY TANK CLOSURE ❑ B TANK REMOVED U/ DBA OR FACILITY NAME WHERE TANK IS INSTALLED: y'r` I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF t1NKNovm S'1'kitc� A. OWNER'S TANK I. 0. N © B. MANUFACTURED BY: o d S C. DATE INSTALLED (MO/OAYNEAR) D. TANK CAPACITY IN GALLONS: /_2 d CO co 1. !AN RI, ItN1J IFA -1 IS MARKED, COMPLETE ITEM C A 1 MOTOR VEHICLE FUEL ❑ 4 OIL g, C t�AR 3 DIESEL❑6 AVIATION GAS ❑2 PETROLEUM ❑ 80 EMPTY 1 PRODUCT4 R --lb GASAHOL ❑ 7METHANOL (❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED UNLEADED ❑ 5 JET FUEL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTH 99 OTHER (DESCRIBE IN ITEM D. BEL01M1n 0. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C. A. S. r Ill. I A19f\ t.U14J I MUG.rRJ1V UAGrt naC irEt. n.0 —1 V. riruvu uvrvnlYlr91 •V•r CIRCLE A IFABOVEGROUNDOR U IFUNOERGROUND,BOTHIFAPPLICABLE A. TYPE OF I DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTH B. TANK ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS d STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 5 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 9 100% METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C. I ❑ 1 RUBBER LINED❑ KYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING LINING ❑ 5 GLASS LINING IS LINING MATERIAL COMPATIBLE S UNLINEO ❑ 95 UNKNOWN ❑ 99 OTHER WITH 100% METHANOL? YES _ NO V D. CORROSION ❑ I POLYETHYLENE WRAP ❑ 2 COATING WRAP ❑ d FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE j93 5 UNKNOWN ❑ 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) IV OVERFILL PREVENTION EOUIPMENT INSTALLED (YEAR) V. riruvu uvrvnlYlr91 •V•r CIRCLE A IFABOVEGROUNDOR U IFUNOERGROUND,BOTHIFAPPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U OOU LE W A U 3 LINED TRENCH A U 95 UNKNOWN A U OTHER C. MATERIAL AND A U i BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE CORROSION PROTECTION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 9 100% METHANOL COMPATIBLE W/FRP A UA GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U gljab;i� C.c> --% D. LEAK DETECTION t AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING to MONRORING ❑ 99 OTHER V. TANK LEAK DETECTION ❑ t VISUAL CHECK ❑ INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING (❑ 6 TANK TESTING 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER v1, 1 AI` r% LLUauP1t !NI-UKMAiIUN 1. ESTIMATED DATE LAST USED (MO/OAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERT MATERIAL YES ❑ NO ❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY. AND TO THF RJcg7' nF AAV i n/nlu/ APPLICANTS NAME (PRINTED a SIGNATURE) DATE LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPnSFn nF TWO 1:0110 M) Iumcce cc1 ntu ?ECT STATE I.D.# COUNTY # JURISDICTION # FACILITY # TANK # CfIN ge "( 3 y ❑❑ � I D y PERMIT NUMBER I PERMIT APPROVED 8Y/DATE PERMIT EXPIRATION DATE Cil 3Ti3 6�iv / � ._.. _ __ _.. Tule en A.1 •n rn•' nw •www.... ....�_ _.. ___._._ ____ ._ rr �o - • �••••• •••��• r.v..vitirrrmcu 0 r A rcnmu ArrUUAI IUN - 1-UHM A, UNLESS A CURRENT FORM A HAS BEEN FILED.